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Charnley Low Friction Arthroplasty for Osteoarthritis. Professor B.M. Wroblewski Mr P. D. Siney Ms P. A. Fleming Mr P. Bobak The John Charnley Research Institute, Wrightington Hospital Research supported by the Peter Kershaw & John Charnley Trusts. in

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charnley low friction arthroplasty for osteoarthritis

Charnley Low Friction Arthroplastyfor Osteoarthritis

Professor B.M. Wroblewski

Mr P. D. Siney

Ms P. A. Fleming

Mr P. Bobak

The John Charnley Research Institute, Wrightington Hospital

Research supported by the Peter Kershaw & John CharnleyTrusts

in

Congenital Dislocation, Subluxation, Dysplasia

slide2

"This type of problem is regarded as too extreme for this type of technical procedure, inviting more technical hazards than the degree of disability warrants.”

Low Friction Arthroplasty in Congenital Subluxation of the Hip.

J. Charnley, J.A. Feagin CORR. No. 91 1973

slide6

Underlying Hip Pathology

Number %

Primary O.A. 298 20.8

CDS/OA 395 27.6

Quadrantic head necrosis 69 4.8

Slipped upper femoral epiphysis 55 3.8

Rheumatoid arthritis 292 20.4

Trauma 85 5.9

Fracture neck of femur 38 2.7

300 patients 395 lfas

300 Patients : 395 LFAs

Ratio : 6 Females to 1 Male

Number %

Male 42 14

Female 258 86

Left 212 54

Right 183 46

weight

Weight

Mean 61.5 kgs

Range 40 - 98

bilateral lfas 48 1

Bilateral LFAs : 48.1%

Patients Hips

Bilateral 95 190

Consecutive 22 44

Staged 73 146

hartofilakidis classification

Hartofilakidis Classification

%

A: Dysplastic hip 32.2

B: Low dislocation 56.6

C: High dislocation 11.2

previous surgery

Previous Surgery

Number %

None 296 75.0

Osteotomy (femoral / pelvic) 59 15.0

Open reduction 17 4.3

Fusion / attempted fusion 10 2.5

Cup arthroplasty 3 0.8

Other (soft tissue procedures) 33 8.6

cup used

Cup Used

%

Offset-bore (38 mm) 10.6

40 mm 47.6

43 mm 41.8

follow up

Follow up

Mean 16.6 years

Range: 1 - 35

clinical results

Clinical Results

Pain free / Occasional discomfort 89.8 %

Normal or near normal function 74.5 %

Normal or near normal movement 72.9 %

complications within one year

Complications within one year

Number %

None 348 88.0

Trochanteric non union 13 3.3

DVT (clinical) 10 2.5

PE (clinical - non fatal) 8 2.0

Dislocation 2 0.5

complications after one year

Complications after one year

Number %

None 264 66.8

Loose cup 72 18.2

Loose stem 20 5.1

Dislocation 5 1.3

Infection 3 0.8

Fractured stem 3 0.8

revisions

Revisions

77 LFAs 19.5%

indications for revision

Indications for Revision

}

16.7

Number %

Loose cup 59

Cup wear 7

Loose stem 17 4.3

Infection 2 0.5

Exploration 8 2.0

follow up1

Follow up

Number %

Lost Patients 26 6.7

LFAs 32 8.8

Died Patients 17 4.4

LFAs 24 6.1

Revised Patients 56 15.0

LFAs 77 19.5

Attending Patients 201 60.2

LFAs 262 66.3

Follow-up 19 years (10-35)

results of thr for ddh without femoral head autograft
Results of THR for DDH without femoral head autograft

Author No Mean FU Revised Loose

(years) % %

MacKenzie 1996 59 16.0 10 32

Pagnano 1996 145 14.0 19 40

Numair 1997 182 9.9 10 6

results of thr for ddh with femoral head autograft
Results of THR for DDH withfemoral head autograft

Author No Mean FU Revised Loose

(years) % %

Mulroy 1990 46 11.8 20 26

Spangehl 2001 44 7.5 9 0

Kobayashi 2003 37 19.0 0 0

slide36

Age at LFA

Average 46 years 3 months

preoperative radiographic evaluation hartofilakidis classification 1988
Preoperative Radiographic Evaluation Hartofilakidis Classification 1988

Dysplasia

1

Low dislocation

29

High dislocation

15

slide38

Previous Surgery

  • Femoral osteotomy 14
  • Open reduction 6
  • Conservative treatment 6
  • Pelvic osteotomies 3
  • Soft tissue release 1
surgical technique
Surgical Technique
  • Trochanteric osteotomy
  • Identification of the tear-drop
  • Acetabular preparation
slide40

Surgical Technique

  • Bone graft preparation and fixation
slide41

Surgical Technique

  • Socket fixation
slide42

Socket coverage by the bone-graft

Average: 26 %

Range: 16 - 35 %

slide43

Socket used

Type Number

Offset-bore (38 mm) 9

40 mm 27

43 mm 9

slide45

Bone Graft

Union rate 100 %

slide46

Bone Graft

Resorption No of hips

None 18

Mild 24

  Moderate 2

Major 1

Time to appearance 3.6 years

slide47

Follow-up

Average : 17 years 1 month

Range: 15 - 21 years

slide48

Revised : 3 hips

- Aseptic cup loosening 2

- Infection 1

Time to revision 13.1 years

radiographic results
Radiographic Results

Socket No of hips

Migrated 3

Fully demarcated 4

Hodgkinson et al COOR 1986

slide53

Radiographic Results : Cup

24 sockets showed demarcation

Demarcation in zone 1 rare

slide57

Conclusion

45 Charnley LFA's

5 died

40 attending follow-up

Average Follow-up: 16 years 5 months

slide58

Conclusion

Sound fixation at primary surgery essential.

Solid graft + impaction bone grafting.

Better bone stock at revision.

The long-term outcome will depend on the rate of cup penetration.